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Alshalah A, Williams DJ, Ferrario A. From fangs to antidotes: A scoping review on snakebite burden, species, and antivenoms in the Eastern Mediterranean Region. PLoS Negl Trop Dis 2024; 18:e0012200. [PMID: 39083539 DOI: 10.1371/journal.pntd.0012200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/07/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Snake bites cause considerable morbidity and mortality worldwide, yet evidence from low- and middle-income countries remains fragmented. This is particularly the case in Eastern Mediterranean Region where available data on snake bites is relatively weak. Without reliable data, it is difficult to make the case for greater visibility and investment to address the snakebite burden in this Region. A scoping review was therefore conducted to summarize evidence on snake bites in countries of the Eastern Mediterranean. METHODOLOGY/PRINCIPAL FINDINGS The review employed manual and electronic searching methods of four databases plus Google Scholar, ultimately including 196 records from 20 countries published between 2000 and 2023. More than half originated from Iran, Morocco, and Pakistan. Many records lacked information on permanent sequalae, disability, snake species, and types and sources of antivenoms. When identified, offending snakes belonged to 30 species. Use of more than 12 types of antivenoms were described across the Region, and some were not specific to indigenous species. CONCLUSION/SIGNIFICANCE Despite the relatively large number of publications identified, the data were concentrated in just a few countries in the Region, and there was little or no information available for the remainder. As is the case worldwide, disability associated with snake bites was poorly characterized and quantified across the Region. There is an urgent need for concrete action at national and regional levels to enhance epidemiological surveillance, research, and the collection of clinical, disability and outcomes data to inform policy and public health investment. Greater regional cooperation and collaboration is also crucial for addressing this neglected disease throughout the Region.
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Affiliation(s)
- Ali Alshalah
- Information Systems for Health Unit, Department of Science, Information and Dissemination, WHO Regional Office for Eastern Mediterranean, Cairo, Egypt
| | - David J Williams
- Regulation and Prequalification Department, World Health Organization, Geneva, Switzerland
| | - Alessandra Ferrario
- Information Systems for Health Unit, Department of Science, Information and Dissemination, WHO Regional Office for Eastern Mediterranean, Cairo, Egypt
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2
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Naz H, Chamola R, Sarafraz J, Razabizadeh M, Jain S. An efficient densenet-based deep learning model for Big-4 snake species classification. Toxicon 2024; 243:107744. [PMID: 38701904 DOI: 10.1016/j.toxicon.2024.107744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/19/2024] [Accepted: 04/30/2024] [Indexed: 05/05/2024]
Abstract
Snakebite poses a significant health threat in numerous tropical and subtropical nations, with around 5.4 million cases reported annually, which results in 1.8-2.7 million instances of envenomation, underscoring its critical impact on public health. The 'BIG FOUR' group comprises the primary committers responsible for most snake bites in India. Effective management of snakebite victims is essential for prognosis, emphasizing the need for preventive measures to limit snakebite-related deaths. The proposed initiative seeks to develop a transfer learning-based image classification algorithm using DenseNet to identify venomous and non-venomous snakes automatically. The study comprehensively evaluates the image classification results, employing accuracy, F1-score, Recall, and Precision metrics. DenseNet emerges as a potent tool for multiclass snake image classification, achieving a notable accuracy rate of 86%. The proposed algorithm intends to be incorporated into an AI-based snake-trapping device with artificial prey made with tungsten wire and vibration motors to mimic heat and vibration signatures, enhancing its appeal to snakes. The proposed algorithm in this research holds promise as a primary tool for preventing snake bites globally, offering a path toward automated snake capture without human intervention. These findings are significant in preventing snake bites and advancing snakebite mitigation strategies.
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Affiliation(s)
- Huma Naz
- School of Computer Science and Engineering, University of Petroleum and Energy Studies Dehradun, India
| | - Rahul Chamola
- Department of Mechanical Engineering, School of Advanced Engineering, University of Petroleum and Energy Studies, Dehradun, India.
| | - Jaleh Sarafraz
- UMR7179 CNRS/MNHN, Département Àdaptations du vivant, Museum National d'Histoire Naturelle, Paris, France
| | - Mahdi Razabizadeh
- Department of Biodiversity, Institute of Science and High Technology and Environmental Sciences, Graduate University of Advanced Technology, Kerman, Iran.
| | - Siddharth Jain
- Department of Mechanical Engineering, School of Advanced Engineering, University of Petroleum and Energy Studies, Dehradun, India
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Shen Y, Hu S, Bao S, Tu M. Clinical characteristics of snakebite patients attending a tertiary hospital in Hangzhou, southeast China. Trans R Soc Trop Med Hyg 2024; 118:287-292. [PMID: 38073610 DOI: 10.1093/trstmh/trad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/01/2023] [Accepted: 11/24/2023] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Venomous snakebite is a neglected yet an important public health problem in China, and few studies have focused on them so far. The aim of this study is to investigate clinical characteristics of snakebites patients in a tertiary hospital in Hangzhou, southeast China. METHODS A total of 416 snakebite cases were included in this retrospective study. The data were collected from the medical records including demographics, clinical manifestations, management and outcomes. RESULTS Of the 416 patients with venomous snakebites, 248 were male, and the average age was 54.6 years. The majority of cases occurred in rural in May to September. Out of all the venomous bites, Gloydius brevicaudus accounted for the highest percentage (55.3%). Hands were the most vulnerable site to snakebites (47.4%). Patients had clinical manifestations of pain (100%), swelling (100%), wound necrosis (25.7%), hemorrhagic blister (18.3%), and blister (8.7%). Three hundred and ninety-two patients received antivenom administration, and most were treated within six hours after bites. Twenty-six patients received surgical treatments, and 90 patients developed venom-induced consumption coagulopathy. No deaths have occurred in this study. CONCLUSION Hangzhou is one of the regions with high affecting of snakebites in China. The results of this study will increase the understanding of the clinical characteristics of venomous snakebites in Hangzhou area.
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Affiliation(s)
- Yuchen Shen
- Department of Dermatology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
| | - Sipin Hu
- Department of Vascular Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Shuhua Bao
- Department of Clinical Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
| | - Mengyun Tu
- Department of Clinical Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
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da Silva WRGB, de Siqueira Santos L, Lira D, de Oliveira Luna KP, Fook SML, Alves RRN. Who are the most affected by Bothrops snakebite envenoming in Brazil? A Clinical-epidemiological profile study among the regions of the country. PLoS Negl Trop Dis 2023; 17:e0011708. [PMID: 37856557 PMCID: PMC10617728 DOI: 10.1371/journal.pntd.0011708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/31/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
Snakebite envenoming represents an important Neglected Tropical Disease (NTD) that mainly affects tropical and subtropical developing countries according to the World Health Organization (WHO). As a priority issue in the tropics, it is estimated that accidental encounter between snakes and humans is the leading cause of morbidity and mortality among all NTDs in the world. In Brazil, an extremely diverse country with continental dimensions, snakebite envenoming is the second leading cause of reported human envenoming. Treating the disease has been an unprecedented challenge for Brazilian Health Systems for decades. Despite access to Antivenom therapy and distributing it free of charge across the country, Brazil faces numerous issues regarding the notification process and accurate treatment targeting for at-risk populations. Thus, this study aimed to identify the temporal epidemiological dynamics of accidents caused by Bothrops snakes in Brazil, the country's major group of venomous snakes, based on secondary information from the online database provided by The Brazilian Notifiable Diseases Information System (SINAN). For this purpose, reported Bothrops snakebites between 2012 and 2021 were counted, then the data were analyzed. We looked at the frequency, occurrence, mortality rates, case fatality rate (CFR), age and gender distribution, and the time lapse between the incident and the initiation of Antivenom therapy. The data were also organized considering regional variations of the country. Throughout the studied period, a total of 202,604 cases of envenoming caused by Bothrops spp. were notified, resulting in 766 fatalities. These accidents were found to occur in variable proportions across different regions in Brazil, with notable concentrations observed in the North, Northeast, and Southeast regions. The epidemiological profile of patients varied greatly between the regions, revealing that snake envenoming is much more a social, economic, and ecological problem than a medical one. In conclusion, our study provides an overview of the clinical and epidemiological profile of envenoming by Bothrops snakes in Brazil. Notably, this is the first study to present such information in a country as vast and diverse as Brazil, encompassing a comparative analysis of its regions using SINAN data, that proves to be a very useful national tool to improve the control and management of envenoming.
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Affiliation(s)
- Weslley Ruan Guimarães Borges da Silva
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Bioinformatics, Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Lucas de Siqueira Santos
- Graduate Program in Geodetic Sciences and Geoinformation Technologies, Department of Cartographic Engineering, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Derick Lira
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ecology and Conservation, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
| | - Karla Patrícia de Oliveira Luna
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Science Teaching and Mathematics Education, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Cellular and Molecular Biology, Department of Molecular Biology, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
| | - Sayonara Maria Lia Fook
- Graduate Program in Public Health, Department of Pharmacy, State University of Paraíba, Campina Grande, Paraíba, Brazil
| | - Rômulo Romeu Nóbrega Alves
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ecology and Conservation, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ethnobiology and Nature Conservation, Federal Rural University of Pernambuco, Recife, Pernambuco, Brazil
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Hsu JY, Chiang SO, Yang CC, Hsieh TW, Chung CJ, Mao YC. Nationwide and long-term epidemiological research of snakebite envenomation in Taiwan during 2002-2014 based on the use of snake antivenoms: A study utilizing National Health Insurance Database. PLoS Negl Trop Dis 2023; 17:e0011376. [PMID: 37289739 DOI: 10.1371/journal.pntd.0011376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/12/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION In Taiwan, six venomous snake species with medical importance have been found; however, long-term epidemiological data of snakebite envenomation (SBE) is lacking. This study aimed to explore the epidemiology of SBE based on the distribution and use of different antivenoms in different parts of Taiwan to facilitate the development of prevention strategies and resource allocation. METHODS AND RESULTS This retrospective study was conducted using the Taiwan National Health Insurance Research Database from 2002 to 2014. A total of 12,542 patients were treated with antivenoms. The directly standardized cumulative incidence was 3.6 cases per 100,000 individuals based on the 2000 World Standard Population. The incidence of SBEs peaked in the summer (35.9%). The relative risk (RR) of male patients versus female patients was 2.5 (p < 0.0001). The RRs of patients aged 18-64 and ≥65 years versus those aged <18 years were 6.0 (p < 0.0001) and 14.3 (p < 0.0001), respectively. Furthermore, the RR of eastern Taiwan versus northern Taiwan was 6.8 (p < 0.0001). The RR of agricultural workers versus laborers was 5.5 (p < 0.0001). Compared with patients envenomed by Trimeresurus stejnegeri stejnegeri or Protobothrops mucrosquamatus, those envenomed by Naja atra or Bungarus multicinctus multicinctus were more likely to occur in central (adjusted odds ratio [aOR] = 2.6, p < 0.0001) or southern (aOR = 3.2, p < 0.0001) Taiwan, but less frequently among agricultural workers (aOR = 0.6, p < 0.0001). The overall case-fatality rate was 0.11%. CONCLUSIONS Among Asian countries, Taiwan had low incidence and case-fatality rates of SBE. Risk factors included male gender, old age, summer season, being in eastern Taiwan, and being an agricultural worker. Differences of the epidemiological findings between snake species should be focused on when developing strategies for snakebite prevention.
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Affiliation(s)
- Jen-Yu Hsu
- Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei, Taiwan
- Office of Preventive Medicine, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-O Chiang
- ESTAT Statistical Consulting Co., Ltd., Taipei, Taiwan
| | - Chen-Chang Yang
- Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tan-Wen Hsieh
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chi-Jung Chung
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Yan-Chiao Mao
- PhD Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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Zhang J, Chen X, Song A, Li X. Artificial intelligence-based snakebite identification using snake images, snakebite wound images, and other modalities of information: A systematic review. Int J Med Inform 2023; 173:105024. [PMID: 36848781 DOI: 10.1016/j.ijmedinf.2023.105024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Artificial intelligence (AI) is widely applied in medical decision support systems. AI also plays an essential role in snakebite identification (SI). To date, no review has been conducted on AI-based SI. This work aims to identify, compare, and summarize the state-of-the-art AI methods in SI. Another objective is to analyze these methods and propose solutions for future directions. METHODS Searches were performed in PubMed, Web of Science, Engineering Village, and IEEE Xplore to identify the SI studies. The datasets, preprocessing, feature extraction, and classification algorithms of these studies were systematically reviewed. Then, their merits and defects were also analyzed and compared. Next, the quality of these studies was assessed by using the ChAIMAI checklist. Finally, solutions were proposed based on the limitations of current studies. RESULTS Twenty-six articles were included in the review. Traditional machine learning (ML) and deep learning (DL) algorithms were applied for the classification of snake images (Acc = 72 %∼98 %), wound images (Acc = 80 %∼100 %), and other modalities of information (Acc = 71.67 %∼97.6 %). According to the research quality assessment, one of the studies was considered to be of high quality. Most studies were flawed in data preparation, data understanding, validation, and deployment dimensions. In addition, we propose an active perception-based system framework for collecting images and bite forces and constructing a multi-modal dataset named "Digital Snake" to address the lack of high-quality datasets for DL algorithms to improve recognition accuracy and robustness. A Snakebite Identification, Treatment, and Management Assistive Platform architecture is also proposed as a decision support system for patients and doctors. CONCLUSIONS AI-based methods can quickly and accurately decide the snake species and classify venomous and non-venomous snakes. Current studies still have limitations in SI. Future studies based on AI methods should focus on constructing high-quality datasets and decision support systems for snakebite treatment.
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Affiliation(s)
- Jun Zhang
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China.
| | - Xin Chen
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
| | - Aiguo Song
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
| | - Xin Li
- Department of Emergency Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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Lee LP, Tan CH, Khomvilai S, Sitprija V, Chaiyabutr N, Tan KY. Characterizing and applying immunoglobulins in snakebite diagnostics: A simple and rapid venom detection assay for four medically important snake species in Southeast Asia. Int J Biol Macromol 2023; 236:123727. [PMID: 36863668 DOI: 10.1016/j.ijbiomac.2023.123727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/28/2023] [Accepted: 02/13/2023] [Indexed: 03/04/2023]
Abstract
Snakebite envenoming is a medical emergency requiring urgent and specific treatment. Unfortunately, snakebite diagnostics are scarce, time-consuming and lacking specificity. Hence, this study aimed to develop a simple, quick and specific snakebite diagnostic assay using animal antibodies. Anti-venom horse immunoglobulin G (IgG) and chicken immunoglobulin Y (IgY) were produced against the venoms of four major medically important snake species in Southeast Asia, i.e., the Monocled Cobra (Naja kaouthia), Malayan Krait (Bungarus candidus), Malayan Pit Viper (Calloselasma rhodostoma), and White-lipped Green Pit Viper (Trimeresurus albolabris). Different capture:detection configurations of double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) were constructed using both immunoglobulins, and the horse IgG:IgG-HRP configuration was found to be most selective and sensitive in detecting the corresponding venoms. The method was further streamlined to develop a rapid immunodetection assay, which is able to produce a visual color change within 30 min for discrimination between different snake species. The study shows it is feasible to develop a simple, quick and specific immunodiagnostic assay using horse IgG, which can be derived directly from antisera prepared for antivenom production. The proof-of-concept indicates it is a sustainable and affordable approach in keeping with on-going antivenom manufacturing activities for specific species in the region.
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Affiliation(s)
- Louisa Pernee Lee
- Venom Research and Toxicology Laboratory, Department of Pharmacology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Choo Hock Tan
- Venom Research and Toxicology Laboratory, Department of Pharmacology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Sumana Khomvilai
- Queen Saovabha Memorial Institute, Thai Red Cross Society, 10330 Bangkok, Thailand
| | - Visith Sitprija
- Queen Saovabha Memorial Institute, Thai Red Cross Society, 10330 Bangkok, Thailand
| | - Narongsak Chaiyabutr
- Queen Saovabha Memorial Institute, Thai Red Cross Society, 10330 Bangkok, Thailand
| | - Kae Yi Tan
- Protein and Interactomics Laboratory, Department of Molecular Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia.
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Agurto-Arteaga A, Vivas-Ruiz DE, Lazo F, Proleón Á, Torrejón D, Electo J, Cayo C, Urra FA, Chávez-Olórtegui C, Sánchez EF, Yarlequé A. Simultaneous identification of three clinically relevant peruvian pit vipers by multiplex loop-mediated isothermal amplification (mLAMP). Toxicon 2023; 223:107022. [PMID: 36621682 DOI: 10.1016/j.toxicon.2023.107022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
Previous knowledge about the taxonomic distribution of venomous snake species is very useful for epidemiological aspects of ophidism. Here, we sought to develop an assay for the differential identification of clinically relevant snakes in Peru: Bothrops atrox, Lachesis muta, and Crotalus durissus using a multiplex loop-mediated isothermal amplification (mLAMP) assay. For this, DNA was extracted from the shed snake skins and the mitochondrial genes Cytb, COI, and 12S rRNA were amplified and further sequenced, for the design of mLAMP reaction primers. For each snake species the forward and reverse primers, internal forward and reverse primers, and the loop primers were obtained, bearing the latter different fluorophores for product identification. Finally, the reaction was standardized in the presence of all primer sets, and an optimal amount of low molecular weight polyethyleneimine. The precipitated products were observed in a UV light transilluminator, finding a differential fluorescence according to the DNA used, with a detection limit to the naked eye in the range of 0.2-25 ng of DNA, within 30 min. This study is the first report on the use of mLAMP technology for the identification of venomous snakes.
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Affiliation(s)
- Andres Agurto-Arteaga
- Laboratorio de Biología Molecular-Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Av. Venezuela Cdra 34 S/N, Ciudad Universitaria, Lima 01, Lima, Peru.
| | - Dan E Vivas-Ruiz
- Laboratorio de Biología Molecular-Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Av. Venezuela Cdra 34 S/N, Ciudad Universitaria, Lima 01, Lima, Peru.
| | - Fanny Lazo
- Laboratorio de Biología Molecular-Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Av. Venezuela Cdra 34 S/N, Ciudad Universitaria, Lima 01, Lima, Peru
| | - Álex Proleón
- Laboratorio de Biología Molecular-Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Av. Venezuela Cdra 34 S/N, Ciudad Universitaria, Lima 01, Lima, Peru
| | - Daniel Torrejón
- Laboratorio de Biología Molecular-Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Av. Venezuela Cdra 34 S/N, Ciudad Universitaria, Lima 01, Lima, Peru
| | - Jorge Electo
- Laboratorio de Biología Molecular-Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Av. Venezuela Cdra 34 S/N, Ciudad Universitaria, Lima 01, Lima, Peru
| | - Carmen Cayo
- Laboratorio de Biología Molecular-Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Av. Venezuela Cdra 34 S/N, Ciudad Universitaria, Lima 01, Lima, Peru
| | - Felix A Urra
- Laboratorio de Plasticidad Metabólica y Bioenergética, Programa de Farmacología Clínica y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, 8380453, Chile
| | - Carlos Chávez-Olórtegui
- Departamento de Bioquímica-Inmunología, Instituto de Ciências Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Minas Gerais, Brazil
| | - Eladio F Sánchez
- Research and Development Center, Ezequiel Dias Foundation, 30510-010, Belo Horizonte, MG, Brazil
| | - Armando Yarlequé
- Laboratorio de Biología Molecular-Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Av. Venezuela Cdra 34 S/N, Ciudad Universitaria, Lima 01, Lima, Peru
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Aron MB, Kachimanga C, Kreuels B, Mailosi B, Sambani C, Matanje BL, Blessmann J, Chunga M, Momba G, Ndarama E, Kambalame DM, Connolly E, Rosenthal A, Munyaneza F. Health care workers' knowledge on identification, management and treatment of snakebite cases in rural Malawi: A descriptive study. PLoS Negl Trop Dis 2022; 16:e0010841. [PMID: 36409666 PMCID: PMC9678285 DOI: 10.1371/journal.pntd.0010841] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022] Open
Abstract
Snakebite envenoming remains a public health threat in many African countries, including Malawi. However, there is a shortage of literature on the knowledge of Health Care Workers (HCWs) and the prevalence of snakebite cases in Malawi. We interviewed HCWs in Neno District to assess their knowledge of snake identification and management of snakebites. We further reviewed patient registers from 2018 to 2021 in all 15 health facilities in the district. We used descriptive statistics to characterize the survey population, knowledge, snake antivenom (SAV) administration, and snake identification. Using "shapefiles" from Open Street Maps, we mapped villages with snakebite cases. Of the 105 HCWs interviewed, 58% were males, and 60% had worked for less than five years. The majority (n = 93, 89%) reported that snakebite envenoming was a problem in the district. Among the clinicians, 42% said they had prescribed SAV previously, while among nurses, only 26% had ever administered SAV. There were discrepancies among clinicians regarding the dosing of snake antivenom. Significant gaps in knowledge also existed regarding snake identification. While two-thirds of HCWs could correctly name and identify venomous snake species, most (> 90%) failed for non-venomous snakes. Most (n = 100, 95%) reported that snakebite victims visit traditional healers more than the hospital. Between 2018 and 2021, the Neno District registered 185 snakebites with a yearly average of 36 cases per 100,000 population. Fifty-two percent (n = 97) were treated as an inpatient; of these cases, 72% were discharged in less than three days, and two died. More snakebite cases were recorded in the eastern part of the district. Significant knowledge gaps exist among HCWs in Neno regarding prescription and administration of SAV and snake identification, which likely challenges the quality of services offered to snakebite victims.
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Affiliation(s)
- Moses Banda Aron
- Partners In Health / Abwenzi Pa Za Umoyo, Neno, Malawi
- Research Group Snakebite Envenoming, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- * E-mail:
| | | | - Benno Kreuels
- Research Group Snakebite Envenoming, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Section for Tropical Medicine, I. Department of Medicine, University Medical Center Hamburg, Germany
| | | | - Clara Sambani
- Department of Research, Ministry of Health, Lilongwe, Malawi
| | | | - Joerg Blessmann
- Research Group Snakebite Envenoming, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Mwayi Chunga
- Partners In Health / Abwenzi Pa Za Umoyo, Neno, Malawi
| | - Grace Momba
- Neno District Health Office, Ministry of Health, Neno, Malawi
| | - Enoch Ndarama
- Neno District Health Office, Ministry of Health, Neno, Malawi
| | | | - Emilia Connolly
- Partners In Health / Abwenzi Pa Za Umoyo, Neno, Malawi
- Division of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Anat Rosenthal
- Department of Health Policy and Management, Ben-Gurion University of the Negev, Beersheba, Israel
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Bolon I, Picek L, Durso AM, Alcoba G, Chappuis F, Ruiz de Castañeda R. An artificial intelligence model to identify snakes from across the world: Opportunities and challenges for global health and herpetology. PLoS Negl Trop Dis 2022; 16:e0010647. [PMID: 35969634 PMCID: PMC9426939 DOI: 10.1371/journal.pntd.0010647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/30/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Snakebite envenoming is a neglected tropical disease that kills an estimated 81,000 to 138,000 people and disables another 400,000 globally every year. The World Health Organization aims to halve this burden by 2030. To achieve this ambitious goal, we need to close the data gap in snake ecology and snakebite epidemiology and give healthcare providers up-to-date knowledge and access to better diagnostic tools. An essential first step is to improve the capacity to identify biting snakes taxonomically. The existence of AI-based identification tools for other animals offers an innovative opportunity to apply machine learning to snake identification and snakebite envenoming, a life-threatening situation.
Methodology
We developed an AI model based on Vision Transformer, a recent neural network architecture, and a comprehensive snake photo dataset of 386,006 training photos covering 198 venomous and 574 non-venomous snake species from 188 countries. We gathered photos from online biodiversity platforms (iNaturalist and HerpMapper) and a photo-sharing site (Flickr).
Principal findings
The model macro-averaged F1 score, which reflects the species-wise performance as averaging performance for each species, is 92.2%. The accuracy on a species and genus level is 96.0% and 99.0%, respectively. The average accuracy per country is 94.2%. The model accurately classifies selected venomous and non-venomous lookalike species from Southeast Asia and sub-Saharan Africa.
Conclusions
To our knowledge, this model’s taxonomic and geographic coverage and performance are unprecedented. This model could provide high-speed and low-cost snake identification to support snakebite victims and healthcare providers in low-resource settings, as well as zoologists, conservationists, and nature lovers from across the world.
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Affiliation(s)
- Isabelle Bolon
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- * E-mail:
| | - Lukáš Picek
- Department of Cybernetics, Faculty of Applied Sciences, University of West Bohemia, Pilsen, Czechia
- PiVa AI s.r.o, Plzeň, Czechia
| | - Andrew M. Durso
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida, United States of America
| | - Gabriel Alcoba
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Médecins Sans Frontières—Doctors Without Borders, Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Rafael Ruiz de Castañeda
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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11
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Wade J, Rimbault C, Ali H, Ledsgaard L, Rivera-de-Torre E, Abou Hachem M, Boddum K, Mirza N, Bohn MF, Sakya SA, Ruso-Julve F, Andersen JT, Laustsen AH. Generation of Multivalent Nanobody-Based Proteins with Improved Neutralization of Long α-Neurotoxins from Elapid Snakes. Bioconjug Chem 2022; 33:1494-1504. [PMID: 35875886 PMCID: PMC9389527 DOI: 10.1021/acs.bioconjchem.2c00220] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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Recombinantly produced biotherapeutics hold promise for
improving
the current standard of care for snakebite envenoming over conventional
serotherapy. Nanobodies have performed well in the clinic, and in
the context of antivenom, they have shown the ability to neutralize
long α-neurotoxins in vivo. Here, we showcase
a protein engineering approach to increase the valence and hydrodynamic
size of neutralizing nanobodies raised against a long α-neurotoxin
(α-cobratoxin) from the venom of the monocled cobraNaja kaouthia. Based on the p53 tetramerization domain,
a panel of anti-α-cobratoxin nanobody-p53 fusion proteins, termed
Quads, were produced with different valences, inclusion or exclusion
of Fc regions for endosomal recycling purposes, hydrodynamic sizes,
and spatial arrangements, comprising up to 16 binding sites. Measurements
of binding affinity and stoichiometry showed that the nanobody binding
affinity was retained when incorporated into the Quad scaffold, and
all nanobody domains were accessible for toxin binding, subsequently
displaying increased blocking potency in vitro compared
to the monomeric format. Moreover, functional assessment using automated
patch-clamp assays demonstrated that the nanobody and Quads displayed
neutralizing effects against long α-neurotoxins from both N. kaouthia and the forest cobra N.
melanoleuca. This engineering approach offers a means
of altering the valence, endosomal recyclability, and hydrodynamic
size of existing nanobody-based therapeutics in a simple plug-and-play
fashion and can thus serve as a technology for researchers tailoring
therapeutic properties for improved neutralization of soluble targets
such as snake toxins.
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Affiliation(s)
- Jack Wade
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens, Lyngby, Denmark
| | - Charlotte Rimbault
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens, Lyngby, Denmark
| | - Hanif Ali
- Quadrucept Bio Ltd., Kemp House, 152 City Road, London EC1V 2NX, United Kingdom
| | - Line Ledsgaard
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens, Lyngby, Denmark
| | - Esperanza Rivera-de-Torre
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens, Lyngby, Denmark
| | - Maher Abou Hachem
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens, Lyngby, Denmark
| | - Kim Boddum
- Sophion Bioscience, DK-2750 Ballerup, Denmark
| | - Nadia Mirza
- Fida Biosystems ApS, DK-2860 Søborg, Copenhagen, Denmark
| | - Markus-Frederik Bohn
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens, Lyngby, Denmark
| | - Siri A. Sakya
- Department of Immunology, Oslo University Hospital Rikshospitalet, N-0372 Oslo, Norway
- Department of Pharmacology, Institute of Clinical Medicine, University of Oslo, N-0372 Oslo, Norway
| | - Fulgencio Ruso-Julve
- Department of Immunology, Oslo University Hospital Rikshospitalet, N-0372 Oslo, Norway
- Department of Pharmacology, Institute of Clinical Medicine, University of Oslo, N-0372 Oslo, Norway
| | - Jan Terje Andersen
- Department of Immunology, Oslo University Hospital Rikshospitalet, N-0372 Oslo, Norway
- Department of Pharmacology, Institute of Clinical Medicine, University of Oslo, N-0372 Oslo, Norway
| | - Andreas H. Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens, Lyngby, Denmark
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12
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Adrião AAX, dos Santos AO, de Lima EJSP, Maciel JB, Paz WHP, da Silva FMA, Pucca MB, Moura-da-Silva AM, Monteiro WM, Sartim MA, Koolen HHF. Plant-Derived Toxin Inhibitors as Potential Candidates to Complement Antivenom Treatment in Snakebite Envenomations. Front Immunol 2022; 13:842576. [PMID: 35615352 PMCID: PMC9126284 DOI: 10.3389/fimmu.2022.842576] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Snakebite envenomations (SBEs) are a neglected medical condition of global importance that mainly affect the tropical and subtropical regions. Clinical manifestations include pain, edema, hemorrhage, tissue necrosis, and neurotoxic signs, and may evolve to functional loss of the affected limb, acute renal and/or respiratory failure, and even death. The standard treatment for snake envenomations is antivenom, which is produced from the hyperimmunization of animals with snake toxins. The inhibition of the effects of SBEs using natural or synthetic compounds has been suggested as a complementary treatment particularly before admission to hospital for antivenom treatment, since these alternative molecules are also able to inhibit toxins. Biodiversity-derived molecules, namely those extracted from medicinal plants, are promising sources of toxin inhibitors that can minimize the deleterious consequences of SBEs. In this review, we systematically synthesize the literature on plant metabolites that can be used as toxin-inhibiting agents, as well as present the potential mechanisms of action of molecules derived from natural sources. These findings aim to further our understanding of the potential of natural products and provide new lead compounds as auxiliary therapies for SBEs.
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Affiliation(s)
- Asenate A. X. Adrião
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Aline O. dos Santos
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Emilly J. S. P. de Lima
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Jéssica B. Maciel
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Weider H. P. Paz
- Post Graduate Program in Chemistry, Department of Chemistry, Federal University of Amazonas, Manaus, Brazil
| | - Felipe M. A. da Silva
- Post Graduate Program in Chemistry, Department of Chemistry, Federal University of Amazonas, Manaus, Brazil
- Multidisciplinary Support Center, Federal University of Amazonas, Manaus, Brazil
| | - Manuela B. Pucca
- Medical School, Federal University of Roraima, Boa Vista, Brazil
| | - Ana M. Moura-da-Silva
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- Laboratory of Immunopathology, Institute Butantan, São Paulo, Brazil
| | - Wuelton M. Monteiro
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Marco A. Sartim
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- University Nilton Lins, Manaus, Brazil
| | - Hector H. F. Koolen
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- Post Graduate Program in Chemistry, Department of Chemistry, Federal University of Amazonas, Manaus, Brazil
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13
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Snakebite epidemiology in humans and domestic animals across the Terai region in Nepal: a multicluster random survey. THE LANCET GLOBAL HEALTH 2022; 10:e398-e408. [DOI: 10.1016/s2214-109x(22)00028-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/22/2021] [Accepted: 01/10/2022] [Indexed: 01/16/2023] Open
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14
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Pinzon RT, Antonius RA, Veronica V. Ischemic Stroke Following Calloselasma rhodostoma Snakebite: A Rare Case Report. Open Access Emerg Med 2022; 14:35-39. [PMID: 35140531 PMCID: PMC8818974 DOI: 10.2147/oaem.s352865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Ischemic stroke following a snakebite is a rare case. Snake venom consists of multiple components which can cause various symptoms and consequences. We report a case of ischemic stroke following Calloselasma rhodostoma snakebite, and this study was the first to report a case of ischemic stroke after snakebite in Indonesia. Case Presentation A 72-year-old Mongoloid male presented with a history of snakebite one day before hospital admission with a swollen right lower leg with no history of hypertension, diabetes mellitus, or heart disease. The patient was conscious. His temperature was 36.5°C, pulse rate was 90 beats per minute, respiration rate was 30 breaths per minute, and blood pressure was 162/109 mmHg. The neurological examination showed left-side weakness and headache, with blood laboratory results showing prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), leucocytosis, thrombocytopenia, and low haemoglobin. A computerized tomogram (CT) scan of the brain was taken, which revealed a sign of infarct in the pericallosal of the right lateral periventricular anterior horn. Conclusion Although ischemic stroke following a snakebite is uncommon, it must be considered and monitored.
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Affiliation(s)
- Rizaldy Taslim Pinzon
- Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
- Department of Neurology, Bethesda Hospital, Yogyakarta, Indonesia
- Correspondence: Rizaldy Taslim Pinzon, Faculty of Medicine, Duta Wacana Christian University, Doctor Wahidin Sudirohusodo street number 5–25, Yogyakarta, 55224, Indonesia, Email
| | | | - Vanessa Veronica
- Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
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15
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Abstract
SNAKE ENVENOMATION REPRESENTS AN IMPORTANT HEALTH PROBLEM IN much of the world. In 2009, it was recognized by the World Health Organization (WHO) as a neglected tropical disease, and in 2017, it was elevated into Category A of the Neglected Tropical Diseases list, further expanding access to funding for research and antivenoms. However, snake envenomation occurs in both tropical and temperate climates and on all continents except Antarctica. Worldwide, the estimated number of annual deaths due to snake envenomation (80,000 to 130,000) is similar to the estimate for drug-resistant tuberculosis and for multiple myeloma., In countries with adequate resources, deaths are infrequent (e.g., <6 deaths per year in the United States, despite the occurrence of 7000 to 8000 bites), but in countries without adequate resources, deaths may number in the tens of thousands. Venomous snakes kept as pets are not rare, and physicians anywhere might be called on to manage envenomation by a nonnative snake. Important advances have occurred in our understanding of the biology of venom and the management of snake envenomation since this topic was last addressed in the Journal two decades ago. For the general provider, it is important to understand the spectrum of snake envenomation effects and approaches to management and to obtain specific guidance, when needed.
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Affiliation(s)
- Steven A Seifert
- From the Department of Emergency Medicine and the New Mexico Poison and Drug Information Center, University of New Mexico Health Sciences Center, Albuquerque (S.A.S.); the Department of Internal Medicine, University of Nebraska Medical Center, Omaha (J.O.A.); and the National Natural Toxins Research Center and the Department of Chemistry, Texas A&M University-Kingsville, Kingsville (E.E.S.)
| | - James O Armitage
- From the Department of Emergency Medicine and the New Mexico Poison and Drug Information Center, University of New Mexico Health Sciences Center, Albuquerque (S.A.S.); the Department of Internal Medicine, University of Nebraska Medical Center, Omaha (J.O.A.); and the National Natural Toxins Research Center and the Department of Chemistry, Texas A&M University-Kingsville, Kingsville (E.E.S.)
| | - Elda E Sanchez
- From the Department of Emergency Medicine and the New Mexico Poison and Drug Information Center, University of New Mexico Health Sciences Center, Albuquerque (S.A.S.); the Department of Internal Medicine, University of Nebraska Medical Center, Omaha (J.O.A.); and the National Natural Toxins Research Center and the Department of Chemistry, Texas A&M University-Kingsville, Kingsville (E.E.S.)
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16
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Malhotra A, Wüster W, Owens JB, Hodges CW, Jesudasan A, Ch G, Kartik A, Christopher P, Louies J, Naik H, Santra V, Kuttalam SR, Attre S, Sasa M, Bravo-Vega C, Murray KA. Promoting co-existence between humans and venomous snakes through increasing the herpetological knowledge base. Toxicon X 2021; 12:100081. [PMID: 34522881 PMCID: PMC8426276 DOI: 10.1016/j.toxcx.2021.100081] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/28/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022] Open
Abstract
Snakebite incidence at least partly depends on the biology of the snakes involved. However, studies of snake biology have been largely neglected in favour of anthropic factors, with the exception of taxonomy, which has been recognised for some decades to affect the design of antivenoms. Despite this, within-species venom variation and the unpredictability of the correlation with antivenom cross-reactivity has continued to be problematic. Meanwhile, other aspects of snake biology, including behaviour, spatial ecology and activity patterns, distribution, and population demography, which can contribute to snakebite mitigation and prevention, remain underfunded and understudied. Here, we review the literature relevant to these aspects of snakebite and illustrate how demographic, spatial, and behavioural studies can improve our understanding of why snakebites occur and provide evidence for prevention strategies. We identify the large gaps that remain to be filled and urge that, in the future, data and relevant metadata be shared openly via public data repositories so that studies can be properly replicated and data used in future meta-analyses.
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Affiliation(s)
- Anita Malhotra
- Molecular Ecology and Evolution @ Bangor, School of Natural Sciences, Bangor University, 3rd floor ECW, Deiniol Road, Bangor, LL57 2UW, UK
| | - Wolfgang Wüster
- Molecular Ecology and Evolution @ Bangor, School of Natural Sciences, Bangor University, 3rd floor ECW, Deiniol Road, Bangor, LL57 2UW, UK
| | - John Benjamin Owens
- Molecular Ecology and Evolution @ Bangor, School of Natural Sciences, Bangor University, 3rd floor ECW, Deiniol Road, Bangor, LL57 2UW, UK
- Captive & Field Herpetology Ltd, Wales, 13 Hirfron, Holyhead, Llaingoch, Anglesey, LL65 1YU, UK
| | - Cameron Wesley Hodges
- School of Biology, Institute of Science, Suranaree University of Technology, Muang Nakhon Ratchasima, Thailand
| | - Allwin Jesudasan
- Madras Crocodile Bank Trust, Centre for Herpetology, Post bag No.4, Vadanamelli Village, East Coast Road, Mamallapuram, 603 104, Tamil Nadu, India
| | - Gnaneswar Ch
- Madras Crocodile Bank Trust, Centre for Herpetology, Post bag No.4, Vadanamelli Village, East Coast Road, Mamallapuram, 603 104, Tamil Nadu, India
| | - Ajay Kartik
- Madras Crocodile Bank Trust, Centre for Herpetology, Post bag No.4, Vadanamelli Village, East Coast Road, Mamallapuram, 603 104, Tamil Nadu, India
| | - Peter Christopher
- Madras Crocodile Bank Trust, Centre for Herpetology, Post bag No.4, Vadanamelli Village, East Coast Road, Mamallapuram, 603 104, Tamil Nadu, India
| | | | - Hiral Naik
- School of Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg. P. O. Wits, 2050, Gauteng, South Africa
- Save the Snakes, R527, Blyderus, Hoedspruit, 1380, South Africa
| | - Vishal Santra
- Captive & Field Herpetology Ltd, Wales, 13 Hirfron, Holyhead, Llaingoch, Anglesey, LL65 1YU, UK
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, West Bengal 712407, India
| | - Sourish Rajagopalan Kuttalam
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, West Bengal 712407, India
| | - Shaleen Attre
- Durrell Institute of Conservation and Ecology, School of Anthropology and Conservation, Marlowe Building, University of Kent, Canterbury, Kent, CT2 7NR, UK
| | - Mahmood Sasa
- Instituto Clodomiro Picado, Universidad de Costa Rica, San José, Costa Rica
- Escuela de Biología, Universidad de Costa Rica, San José, Costa Rica
| | - Carlos Bravo-Vega
- Research Group in Mathematical and Computational Biology (BIOMAC), Department of Biomedical Engineering, University of the Andes, Bogotá, Colombia
| | - Kris A. Murray
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Gambia
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17
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Cytotoxin antibody-based colourimetric sensor for field-level differential detection of elapid among big four snake venom. PLoS Negl Trop Dis 2021; 15:e0009841. [PMID: 34634067 PMCID: PMC8530336 DOI: 10.1371/journal.pntd.0009841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/21/2021] [Accepted: 09/27/2021] [Indexed: 11/19/2022] Open
Abstract
Development of a rapid, on-site detection tool for snakebite is highly sought after, owing to its clinically and forensically relevant medicolegal significance. Polyvalent antivenom therapy in the management of such envenomation cases is finite due to its poor venom neutralization capabilities as well as diagnostic ramifications manifested as untoward immunological reactions. For precise molecular diagnosis of elapid venoms of the big four snakes, we have developed a lateral flow kit using a monoclonal antibody (AB1; IgG1 – κ chain; Kd: 31 nM) generated against recombinant cytotoxin-7 (rCTX-7; 7.7 kDa) protein of the elapid venom. The monoclonal antibody specifically detected the venoms of Naja naja (p < 0.0001) and Bungarus caeruleus (p<0.0001), without showing any immunoreactivity against the viperidae snakes in big four venomous snakes. The kit developed attained the limit of quantitation of 170 pg/μL and 2.1 ng/μL in spiked buffer samples and 28.7 ng/μL and 110 ng/μL in spiked serum samples for detection of N. naja and B. caeruleus venoms, respectively. This kit holds enormous potential in identification of elapid venom of the big four snakes for effective prognosis of an envenomation; as per the existing medical guidelines. Detection of the snake species responsible for the envenomation in a victim is crucial for clinical and forensic management of poisoning cases. Polyvalent antivenom therapy can seldom lead to immunological complications manifested in the form of symptoms ranging from serum sickness to myalgia. Use of monovalent antivenom therapy is being recommended for targeted venom neutralization in envenomed individuals with minimum side effects. Moreover, the development of field applicable venom detection devices is the need of the hour for enabling orderly detection of poisoning cases at the crime scene, besides testing for illegal trade of snake parts, including venom, protected under the Wildlife Act. The monovalent antivenom therapy and the field level detection of venom conducive to adequate crime scene management is limited by the tools available for species or family-specific identification of the venom under question. For differential detection of the Elapids of the big four snakes from the Viperidae, we have developed a monoclonal antibody-based lateral flow assay kit using recombinant Cytotoxin– 7 protein. The limit of quantitation for the detection of venoms of N. naja and B. caeruleus was ascertained to be 170 pg/μL and 2.1 ng/ μL in spiked buffer samples and 28.7 ng/ μL and 110 ng/ μL in spiked serum samples, respectively. Thus, the kit can effectively detect the venoms of elapids of the big four snakes in both simple and complex matrices of the samples and can be adapted for its use in differential diagnosis.
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18
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Darshani S, Gnanathasan A, Arambepola C, Chang T. Knowledge on prevention, diagnosis and treatment of snakebite envenoming among doctors in snakebite-dense regions in Sri Lanka. Trans R Soc Trop Med Hyg 2021; 115:984-991. [PMID: 34323280 DOI: 10.1093/trstmh/trab112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sri Lanka is one of the highest envenoming reporting countries globally with >80 000 snakebites per year. Among other factors, knowledge of snakebite among doctors predominantly determines patient outcomes. METHODS Using a pretested 72-item self-administered questionnaire, we assessed knowledge on identifying common snake species, signs of envenoming and management of venomous snakebites among 280 doctors working in eight state hospitals in regions where snakebite prevalence is highest in Sri Lanka. RESULTS Visually, 92.1% correctly identified a cobra and 74.3% identified a Russell's viper, but only 30% could identify a hump-nosed viper (HNV). Syndromic identification of snakes was best for the krait (71.8%) followed by the cobra (59.6%), but poor for the HNV (30%). The median knowledge scores of pictorial and syndromic snake identification, indoor preventive measures and indications of antivenom were <75% of the maximum score. Apart from 62.5% who expected the victim to bring the snake along to the hospital, most doctors selected the correct options of pre-hospital care. The duration of work experience did not influence the competency of syndromic identification. Utilisation of local guidelines was associated with better knowledge in antivenom usage (odds ratio 2.22 [95% confidence interval 1.04 to 5.36]; p=0.03). CONCLUSIONS Specific deficiencies of core knowledge in snakebite management exist among doctors working in snakebite prevalent regions.
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Affiliation(s)
| | | | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo 00800, Sri Lanka
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19
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Mukherjee AK, Mackessy SP. Prevention and improvement of clinical management of snakebite in Southern Asian countries: A proposed road map. Toxicon 2021; 200:140-152. [PMID: 34280412 DOI: 10.1016/j.toxicon.2021.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
In the Southern Asian countries, snakebite takes a substantial toll in terms of human life, inflicts acute morbidity and long term disability both physical and psychological, and therefore represents a neglected socio-economic problem and severe health issue that requires immediate medical attention. The 'Big Four' venomous snakes, viz. Daboia russelii, Naja naja, Bungarus caeruleus and Echis carinatus, are prominent, medically important species and are the most dangerous snakes of this region; therefore, the commercial polyvalent antivenom (PAV) contains antibodies against the venoms of these snakes. However, envenomations by species other than the 'Big Four' snakes are grossly neglected, and PAV is only partially effective in neutralizing the venom of these snakes. Many issues confounding effective treatment of snakebite are discussed in this review, and these hurdles preventing successful treatment of snakebite must be addressed. However, in South Asian countries, the pre-hospital treatment and appropriate first aid are equally important to mitigate the problem of snakebite and therefore, these issues are also highlighted here. Further, this review suggests a roadmap and guidelines for the prevention of snakebite and improvement of hospital management of snakebite in these Southern Asian countries.
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Affiliation(s)
- Ashis K Mukherjee
- Division of Life Sciences, Institute of Advanced Study in Science and Technology, Vigyan Path Garchuk, Paschim Boragaon, Guwahati, 781035, Assam, India; Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, 78028, Assam, India; School of Biological Sciences, University of Northern Colorado, Greeley, CO, 80639-0017, USA.
| | - Stephen P Mackessy
- School of Biological Sciences, University of Northern Colorado, Greeley, CO, 80639-0017, USA
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20
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Hamza M, Knudsen C, Gnanathasan CA, Monteiro W, Lewin MR, Laustsen AH, Habib AG. Clinical management of snakebite envenoming: Future perspectives. Toxicon X 2021; 11:100079. [PMID: 34430847 PMCID: PMC8374517 DOI: 10.1016/j.toxcx.2021.100079] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/29/2021] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
Snakebite envenoming is a major cause of morbidity and mortality in rural communities throughout the tropics. Generally, the main clinical features of snakebites are local swelling, tissue necrosis, shock, spontaneous systemic hemorrhage, incoagulable blood, paralysis, rhabdomyolysis, and acute kidney injury. These clinical manifestations result from complex biochemical venom constituents comprising of cytotoxins, hemotoxins, neurotoxins, myotoxins, and other substances. Timely diagnosis of envenoming and identification of the responsible snake species is clinically challenging in many parts of the world and necessitates prompt and thorough clinical assessment, which could be supported by the development of reliable, affordable, widely-accessible, point-of-care tests. Conventional antivenoms based on polyclonal antibodies derived from animals remain the mainstay of therapy along with supportive medical and surgical care. However, while antivenoms save countless lives, they are associated with adverse reactions, limited potency, and are relatively inefficacious against presynaptic neurotoxicity and in preventing necrosis. Nevertheless, major scientific and technological advances are facilitating the development of new molecular and immunologic diagnostic tests, as well as a new generation of antivenoms comprising human monoclonal antibodies with broader and more potent neutralization capacity and less immunogenicity. Repurposed pharmaceuticals based on small molecule inhibitors (e.g., marimastat and varespladib) used alone and in combination against enzymatic toxins, such as metalloproteases and phospholipase A2s, have shown promise in animal studies. These orally bioavailable molecules could serve as early interventions in the out-of-hospital setting if confirmed to be safe and efficacious in clinical studies. Antivenom access can be improved by the usage of drones and ensuring constant antivenom supply in remote endemic rural areas. Overall, the improvement of clinical management of snakebite envenoming requires sustained, coordinated, and multifaceted efforts involving basic and applied sciences, new technology, product development, effective clinical training, implementation of existing guidelines and therapeutic approaches, supported by improved supply of existing antivenoms.
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Affiliation(s)
- Muhammad Hamza
- Infectious and Tropical Diseases Unit, Bayero University Kano, Nigeria
| | - Cecilie Knudsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | - Wuelton Monteiro
- Department of Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Matthew R. Lewin
- Center for Exploration and Travel Health, California Academy of Sciences, San Francisco, USA
| | - Andreas H. Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
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21
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Duda R, Monteiro WM, Giles-Vernick T. Integrating lay knowledge and practice into snakebite prevention and care in central Africa, a hotspot for envenomation. Toxicon X 2021; 11:100077. [PMID: 34381993 PMCID: PMC8334740 DOI: 10.1016/j.toxcx.2021.100077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022] Open
Abstract
The WHO has identified the goal of halving deaths and disability from snakebite envenomation (SBE) by 2030 through a four-pillar program that promotes accessible and affordable treatments, strengthens health systems, promotes community and multi-level engagement, and mobilizes partnerships, coordination and resources to advocate for global action. This initiative could accelerate multi-disciplinary research and action in central Africa, a “hotspot” for SBE, but it offers little specific guidance about anthropological research to be conducted. This commentary develops that research agenda. It surveys anthropological, ethnohistorical investigations in the central African forest to elaborate the socio-cultural and historical significance and practices around snakes and snakebites. It draws from south and southeast Asian and Latin American literatures to illustrate anthropological contributions to SBE research. It then outlines a Central African research agenda employing ethnobiological investigation of snake ecologies, participatory evaluations of humans-snake contacts, and interviews and participant-observation of local prevention and treatment practices and knowledge. This research will co-develop policies and practices with forest communities and leaders and regional and national authorities to reduce the burden of SBE. Central African forests are a hotspot for snakebite envenomation. SBE research in central Africa has not mobilized anthropological literatures or methodologies. Policies to reduce SBE burden in central Africa should build on participatory research. Policies to reduce SBE burden should be co-developed with local and national stakeholders.
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Affiliation(s)
- Romain Duda
- Anthropology & Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France
| | - Wuelton M Monteiro
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil.,Department of Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Tamara Giles-Vernick
- Anthropology & Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France
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22
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Durso AM, Ruiz de Castañeda R, Montalcini C, Mondardini MR, Fernandez-Marques JL, Grey F, Müller MM, Uetz P, Marshall BM, Gray RJ, Smith CE, Becker D, Pingleton M, Louies J, Abegg AD, Akuboy J, Alcoba G, Daltry JC, Entiauspe-Neto OM, Freed P, de Freitas MA, Glaudas X, Huang S, Huang T, Kalki Y, Kojima Y, Laudisoit A, Limbu KP, Martínez-Fonseca JG, Mebert K, Rödel MO, Ruane S, Ruedi M, Schmitz A, Tatum SA, Tillack F, Visvanathan A, Wüster W, Bolon I. Citizen science and online data: Opportunities and challenges for snake ecology and action against snakebite. Toxicon X 2021; 9-10:100071. [PMID: 34278294 PMCID: PMC8264216 DOI: 10.1016/j.toxcx.2021.100071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 12/03/2022] Open
Abstract
The secretive behavior and life history of snakes makes studying their biology, distribution, and the epidemiology of venomous snakebite challenging. One of the most useful, most versatile, and easiest to collect types of biological data are photographs, particularly those that are connected with geographic location and date-time metadata. Photos verify occurrence records, provide data on phenotypes and ecology, and are often used to illustrate new species descriptions, field guides and identification keys, as well as in training humans and computer vision algorithms to identify snakes. We scoured eleven online and two offline sources of snake photos in an attempt to collect as many photos of as many snake species as possible, and attempt to explain some of the inter-species variation in photograph quantity among global regions and taxonomic groups, and with regard to medical importance, human population density, and range size. We collected a total of 725,565 photos-between 1 and 48,696 photos of 3098 of the world's 3879 snake species (79.9%), leaving 781 "most wanted" species with no photos (20.1% of all currently-described species as of the December 2020 release of The Reptile Database). We provide a list of most wanted species sortable by family, continent, authority, and medical importance, and encourage snake photographers worldwide to submit photos and associated metadata, particularly of "missing" species, to the most permanent and useful online archives: The Reptile Database, iNaturalist, and HerpMapper.
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Affiliation(s)
- Andrew M. Durso
- Department of Biological Sciences, Florida Gulf Coast University, Ft. Myers, FL, USA
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Rafael Ruiz de Castañeda
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- World Health Organization, Geneva, Switzerland
| | | | - M. Rosa Mondardini
- Citizen Science Center Zürich (ETH Zürich and University of Zürich), Zürich, Switzerland
| | | | | | | | - Peter Uetz
- The Reptile Database, Richmond, VA, USA
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | | | | | | | | | - Arthur D. Abegg
- Instituto Butantan, São Paulo, São Paulo, Brazil
- University of São Paulo, São Paulo, São Paulo, Brazil
| | - Jeannot Akuboy
- University of Kisangani, Kisangani, Democratic Republic of the Congo
| | | | - Jennifer C. Daltry
- Flora & Fauna International, Cambridge, England, UK
- Global Wildlife Conservation, Austin, TX, USA
| | | | - Paul Freed
- The Reptile Database, Richmond, VA, USA
- Reptile Database, Scotts Mills, OR, USA
| | | | - Xavier Glaudas
- University of the Witwatersrand, Johannesburg, South Africa
- Bangor University, Bangor, Wales, UK
| | - Song Huang
- Anhui Normal University, Wuhu, Anhui, China
| | | | - Yatin Kalki
- Madras Crocodile Bank Trust, Mahabalipuram, Tamil Nadu, India
| | | | | | | | | | - Konrad Mebert
- Global Biology, Birr, Switzerland
- Institute of Development, Ecology, Conservation & Cooperation, Rome, Italy
| | - Mark-Oliver Rödel
- Museum für Naturkunde - Leibniz Institute for Evolution and Biodiversity Science, Berlin, Germany
| | | | - Manuel Ruedi
- Museum d'Histoire naturelle Geneve, Geneva, Switzerland
| | | | | | - Frank Tillack
- Museum für Naturkunde - Leibniz Institute for Evolution and Biodiversity Science, Berlin, Germany
| | | | - Wolfgang Wüster
- Molecular Ecology and Fisheries Genetics Laboratory, School of Natural Sciences, Bangor University, Bangor, Wales, UK
| | - Isabelle Bolon
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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23
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Damm M, Hempel BF, Süssmuth RD. Old World Vipers-A Review about Snake Venom Proteomics of Viperinae and Their Variations. Toxins (Basel) 2021; 13:toxins13060427. [PMID: 34204565 PMCID: PMC8235416 DOI: 10.3390/toxins13060427] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 12/12/2022] Open
Abstract
Fine-tuned by millions of years of evolution, snake venoms have frightened but also fascinated humanity and nowadays they constitute potential resources for drug development, therapeutics and antivenoms. The continuous progress of mass spectrometry techniques and latest advances in proteomics workflows enabled toxinologists to decipher venoms by modern omics technologies, so-called ‘venomics’. A tremendous upsurge reporting on snake venom proteomes could be observed. Within this review we focus on the highly venomous and widely distributed subfamily of Viperinae (Serpentes: Viperidae). A detailed public literature database search was performed (2003–2020) and we extensively reviewed all compositional venom studies of the so-called Old-World Vipers. In total, 54 studies resulted in 89 venom proteomes. The Viperinae venoms are dominated by four major, four secondary, six minor and several rare toxin families and peptides, respectively. The multitude of different venomics approaches complicates the comparison of venom composition datasets and therefore we differentiated between non-quantitative and three groups of quantitative workflows. The resulting direct comparisons within these groups show remarkable differences on the intra- and interspecies level across genera with a focus on regional differences. In summary, the present compilation is the first comprehensive up-to-date database on Viperinae venom proteomes and differentiating between analytical methods and workflows.
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Affiliation(s)
- Maik Damm
- Department of Chemistry, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany;
| | - Benjamin-Florian Hempel
- BIH Center for Regenerative Therapies, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, (BCRT), 10117 Berlin, Germany;
| | - Roderich D. Süssmuth
- Department of Chemistry, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany;
- Correspondence: ; Tel.: +49-(0)30-314-24205
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24
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Knudsen C, Jürgensen JA, Føns S, Haack AM, Friis RUW, Dam SH, Bush SP, White J, Laustsen AH. Snakebite Envenoming Diagnosis and Diagnostics. Front Immunol 2021; 12:661457. [PMID: 33995385 PMCID: PMC8113877 DOI: 10.3389/fimmu.2021.661457] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Snakebite envenoming is predominantly an occupational disease of the rural tropics, causing death or permanent disability to hundreds of thousands of victims annually. The diagnosis of snakebite envenoming is commonly based on a combination of patient history and a syndromic approach. However, the availability of auxiliary diagnostic tests at the disposal of the clinicians vary from country to country, and the level of experience within snakebite diagnosis and intervention may be quite different for clinicians from different hospitals. As such, achieving timely diagnosis, and thus treatment, is a challenge faced by treating personnel around the globe. For years, much effort has gone into developing novel diagnostics to support diagnosis of snakebite victims, especially in rural areas of the tropics. Gaining access to affordable and rapid diagnostics could potentially facilitate more favorable patient outcomes due to early and appropriate treatment. This review aims to highlight regional differences in epidemiology and clinical snakebite management on a global scale, including an overview of the past and ongoing research efforts within snakebite diagnostics. Finally, the review is rounded off with a discussion on design considerations and potential benefits of novel snakebite diagnostics.
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Affiliation(s)
- Cecilie Knudsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
- BioPorto Diagnostics A/S, Hellerup, Denmark
| | - Jonas A. Jürgensen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Sofie Føns
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Aleksander M. Haack
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Rasmus U. W. Friis
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Søren H. Dam
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Sean P. Bush
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Julian White
- Toxinology Department, Women’s and Children’s Hospital, North Adelaide, SA, Australia
| | - Andreas H. Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
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25
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Durso AM, Moorthy GK, Mohanty SP, Bolon I, Salathé M, Ruiz de Castañeda R. Supervised Learning Computer Vision Benchmark for Snake Species Identification From Photographs: Implications for Herpetology and Global Health. Front Artif Intell 2021; 4:582110. [PMID: 33959704 PMCID: PMC8093445 DOI: 10.3389/frai.2021.582110] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 02/09/2021] [Indexed: 11/29/2022] Open
Abstract
We trained a computer vision algorithm to identify 45 species of snakes from photos and compared its performance to that of humans. Both human and algorithm performance is substantially better than randomly guessing (null probability of guessing correctly given 45 classes = 2.2%). Some species (e.g., Boa constrictor) are routinely identified with ease by both algorithm and humans, whereas other groups of species (e.g., uniform green snakes, blotched brown snakes) are routinely confused. A species complex with largely molecular species delimitation (North American ratsnakes) was the most challenging for computer vision. Humans had an edge at identifying images of poor quality or with visual artifacts. With future improvement, computer vision could play a larger role in snakebite epidemiology, particularly when combined with information about geographic location and input from human experts.
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Affiliation(s)
- Andrew M Durso
- Department of Biological Sciences, Florida Gulf Coast University, Ft. Myers, FL, United States.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | | | - Isabelle Bolon
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marcel Salathé
- AICrowd, Lausanne, Switzerland.,Digital Epidemiology Laboratory, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
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26
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Di Nicola MR, Pontara A, Kass GEN, Kramer NI, Avella I, Pampena R, Mercuri SR, Dorne JLCM, Paolino G. Vipers of Major clinical relevance in Europe: Taxonomy, venom composition, toxicology and clinical management of human bites. Toxicology 2021; 453:152724. [PMID: 33610611 DOI: 10.1016/j.tox.2021.152724] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 12/14/2022]
Abstract
Snakebites in Europe are mostly due to bites from Viperidae species of the genus Vipera. This represents a neglected public health hazard with poorly defined incidence, morbidity and mortality. In Europe, fourteen species of "true vipers" (subfamily Viperinae) are present, eleven of which belong to the genus Vipera. Amongst these, the main medically relevant species due to their greater diffusion across Europe and the highest number of registered snakebites are six, namely: Vipera ammodytes, V. aspis, V. berus, V. latastei, V. seoanei and V. ursinii. Generally speaking, viper venom composition is characterised by many different toxin families, like phospholipases A2, snake venom serine proteases, snake venom metalloproteases, cysteine-rich secretory proteins, C-type lectins, disintegrins, haemorrhagic factors and coagulation inhibitors. A suspected snakebite is often associated with severe pain, erythema, oedema and, subsequently, the onset of an ecchymotic area around one or two visible fang marks. In the field, the affected limb should be immobilised and mildly compressed with a bandage, which can then be removed once the patient is being treated in hospital. The clinician should advise the patient to remain calm to reduce blood circulation and, therefore, decrease the spread of the toxins. In the case of pain, an analgesic therapy can be administered, the affected area can be treated with hydrogen peroxide or clean water. However, anti-inflammatory drugs and disinfection with alcohol or alcoholic substances should be avoided. For each patient, clinical chemistry and ECG are always a pre-requisite as well as the evaluation of the tetanus immunisation status and for which immunisation may be provided if needed. The treatment of any clinical complication, due to the envenomation, does not differ from treatments of emergency nature. Antivenom is recommended when signs of systemic envenomation exist or in case of advanced local or systemic progressive symptoms. Recommendations for future work concludes. The aim of this review is to support clinicians for the clinical management of viper envenomation, through taxonomic keys for main species identification, description of venom composition and mode of action of known toxins and provide a standardised clinical protocol and antivenom administration.
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Affiliation(s)
| | - Andrea Pontara
- Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - George E N Kass
- European Food Safety Authority, Scientific Committee and Emerging Risks unit, 43126 Parma, Italy
| | - Nynke I Kramer
- Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, the Netherlands
| | - Ignazio Avella
- CIBIO/InBIO - Centro de Investigação em Biodiversidade e Recursos Genéticos da Universidade do Porto, Rua Padre Armando Quintas 7, 4485-661, Vairão, Portugal; Evolutionary and Translational Venomics Laboratory, Instituto de Biomedicina de Valencia - CSIC, Calle Jaime Roig 11, 46010, Valencia, Spain
| | - Riccardo Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | | | - Jean Lou C M Dorne
- European Food Safety Authority, Scientific Committee and Emerging Risks unit, 43126 Parma, Italy
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27
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Sunagar K, Abraham SV. The Curious Case of the "Neurotoxic Skink": Scientific Literature Points to the Absence of Venom in Scincidae. Toxins (Basel) 2021; 13:toxins13020114. [PMID: 33546362 PMCID: PMC7913497 DOI: 10.3390/toxins13020114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
In contrast to the clearly documented evolution of venom in many animal lineages, the origin of reptilian venom is highly debated. Historically, venom has been theorised to have evolved independently in snakes and lizards. However, some of the recent works have argued for the common origin of venom in “Toxicofera” reptiles, which include the order Serpentes (all snakes), and Anguimorpha and Iguania lizards. Nevertheless, in both these contrasting hypotheses, the lizards of the family Scincidae are considered to be harmless and devoid of toxic venoms. Interestingly, an unusual clinical case claiming neurotoxic envenoming by a scincid lizard was recently reported in Southern India. Considering its potentially significant medicolegal, conservation and evolutionary implications, we have summarised the scientific evidence that questions the validity of this clinical report. We argue that the symptoms documented in the patient are likely to have resulted from krait envenomation, which is far too frequent in these regions.
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Affiliation(s)
- Kartik Sunagar
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore 560012, Karnataka, India
- Correspondence:
| | - Siju V Abraham
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India;
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28
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Durso AM, Bolon I, Kleinhesselink AR, Mondardini MR, Fernandez-Marquez JL, Gutsche-Jones F, Gwilliams C, Tanner M, Smith CE, Wüster W, Grey F, Ruiz de Castañeda R. Crowdsourcing snake identification with online communities of professional herpetologists and avocational snake enthusiasts. ROYAL SOCIETY OPEN SCIENCE 2021; 8:201273. [PMID: 33614073 PMCID: PMC7890515 DOI: 10.1098/rsos.201273] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
Species identification can be challenging for biologists, healthcare practitioners and members of the general public. Snakes are no exception, and the potential medical consequences of venomous snake misidentification can be significant. Here, we collected data on identification of 100 snake species by building a week-long online citizen science challenge which attracted more than 1000 participants from around the world. We show that a large community including both professional herpetologists and skilled avocational snake enthusiasts with the potential to quickly (less than 2 min) and accurately (69-90%; see text) identify snakes is active online around the clock, but that only a small fraction of community members are proficient at identifying snakes to the species level, even when provided with the snake's geographical origin. Nevertheless, participants showed great enthusiasm and engagement, and our study provides evidence that innovative citizen science/crowdsourcing approaches can play significant roles in training and building capacity. Although identification by an expert familiar with the local snake fauna will always be the gold standard, we suggest that healthcare workers, clinicians, epidemiologists and other parties interested in snakebite could become more connected to these communities, and that professional herpetologists and skilled avocational snake enthusiasts could organize ways to help connect medical professionals to crowdsourcing platforms. Involving skilled avocational snake enthusiasts in decision making could build the capacity of healthcare workers to identify snakes more quickly, specifically and accurately, and ultimately improve snakebite treatment data and outcomes.
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Affiliation(s)
- A. M. Durso
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Biological Sciences, Florida Gulf Coast University, Ft. Myers, FL, USA
| | - I. Bolon
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - A. R. Kleinhesselink
- Department of Ecology and Evolutionary Biology, University of California Los Angeles, Los Angeles, CA, USA
| | - M. R. Mondardini
- Citizen Science Center Zürich, ETHZ and University of Zürich, Zurich, Switzerland
| | | | - F. Gutsche-Jones
- Citizen Science Center Zürich, ETHZ and University of Zürich, Zurich, Switzerland
| | - C. Gwilliams
- Citizen Science Center Zürich, ETHZ and University of Zürich, Zurich, Switzerland
| | - M. Tanner
- Citizen Science Center Zürich, ETHZ and University of Zürich, Zurich, Switzerland
| | | | - W. Wüster
- Bangor University College of Natural Sciences, Bangor, UK
| | - F. Grey
- Citizen Cyberlab, University of Geneva, Geneva, Switzerland
| | - R. Ruiz de Castañeda
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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29
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Huang F, Zhao S, Tong F, Liang Y, Le Grange JM, Kuang W, Zhou Y. Unexpected death in a young man associated with a unilateral swollen leg: Pathological and toxicological findings in a fatal snakebite from Deinagkistrodon acutus (Chinese moccasin). J Forensic Sci 2020; 66:786-792. [PMID: 33227152 DOI: 10.1111/1556-4029.14622] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 01/08/2023]
Abstract
Deinagkistrodon acutus (D. acutus), also known as the Chinese moccasin, is a viper species found throughout the southeastern parts of China, northern Vietnam and Laos. D. acutus envenomation can result in coagulopathy and lead to death if not treated correctly. A 20-year-old man was discovered with a severely swollen left thigh with overlying dark purple, discolored skin. He was immediately transported to hospital. Laboratory examinations revealed dysfunctional coagulation and fluid-electrolyte imbalances. He died 2 h later despite resuscitation efforts. Surveillance footage revealed that he had walked through a grass field while returning home that night. Autopsy and pathological examination findings revealed a large area of muscle necrosis of the left thigh, renal tubular necrosis, and hepatocyte necrosis. Potential fang marks were found on the decedent's jeans. Due to our suspicions, we performed specific enzyme-linked immunosorbent assays (ELISA) and detected D. acutus venom in the kidneys, left thigh muscle, liver, lung, spleen, and heart tissues of the decedent. In conclusion, the clinical manifestations, autopsy, histopathological examination, ELISA, and investigation results confirmed D. acutus envenomation.
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Affiliation(s)
- Fang Huang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuquan Zhao
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Tong
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Liang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jehane Michael Le Grange
- The First Clinical College, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenhua Kuang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiwu Zhou
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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30
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Ganança PHS, Fraga RD, Vasconcelos Neto LBD, Santos Júnior APD. A case report of human intoxication due to a snakebite by the opisthoglyphous dipsadid Thamnodynastes lanei Bailey, Thomas & Silva-Jr, 2005. Rev Soc Bras Med Trop 2020; 54:e20200194. [PMID: 33206870 PMCID: PMC7723376 DOI: 10.1590/0037-8682-0194-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/29/2020] [Indexed: 11/22/2022] Open
Abstract
We present a case of human intoxication due to a snakebite by the opisthoglyphous dipsadid Thamnodynastes lanei. A 26-year-old man was bitten on the right hand and was not medicated. Bleeding lasted a few seconds, while paresthesia, chills, and headache persisted for up to 10 hours. The pain disappeared after a week, and the edema, itching, and prickling persisted for another 3 days. Although this patient’s symptoms were typical of bites by South American opisthoglyphous snakes, they persisted longer than those of bites by some congeneric species. Our report adds a species to the list of medically relevant snakes.
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Affiliation(s)
- Pedro Henrique Salomão Ganança
- Universidade Federal do Oeste do Pará, Instituto de Ciências da Educação, Laboratório de Ecologia e Comportamento Animal, Santarém, PA, Brasil.,Universidade Federal do Oeste do Pará, Instituto de Ciências e Tecnologia das Águas, Programa de Pós-Graduação em Biodiversidade, Santarém, PA, Brasil
| | - Rafael de Fraga
- Universidade Federal do Oeste do Pará, Instituto de Ciências da Educação, Laboratório de Ecologia e Comportamento Animal, Santarém, PA, Brasil.,Universidade Federal do Oeste do Pará, Programa de Pós-graduação em Recursos Naturais da Amazônia, Santarém, PA, Brasil
| | - Lourival Baía de Vasconcelos Neto
- Universidade Federal do Oeste do Pará, Instituto de Ciências da Educação, Laboratório de Ecologia e Comportamento Animal, Santarém, PA, Brasil.,Universidade Federal do Oeste do Pará, Instituto de Ciências e Tecnologia das Águas, Programa de Pós-Graduação em Biodiversidade, Santarém, PA, Brasil
| | - Alfredo Pedroso Dos Santos Júnior
- Universidade Federal do Oeste do Pará, Instituto de Ciências da Educação, Laboratório de Ecologia e Comportamento Animal, Santarém, PA, Brasil.,Universidade Federal do Oeste do Pará, Instituto de Ciências e Tecnologia das Águas, Programa de Pós-Graduação em Biodiversidade, Santarém, PA, Brasil
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Pucca MB, Knudsen C, S. Oliveira I, Rimbault C, A. Cerni F, Wen FH, Sachett J, Sartim MA, Laustsen AH, Monteiro WM. Current Knowledge on Snake Dry Bites. Toxins (Basel) 2020; 12:E668. [PMID: 33105644 PMCID: PMC7690386 DOI: 10.3390/toxins12110668] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022] Open
Abstract
Snake 'dry bites' are characterized by the absence of venom being injected into the victim during a snakebite incident. The dry bite mechanism and diagnosis are quite complex, and the lack of envenoming symptoms in these cases may be misinterpreted as a miraculous treatment or as proof that the bite from the perpetrating snake species is rather harmless. The circumstances of dry bites and their clinical diagnosis are not well-explored in the literature, which may lead to ambiguity amongst treating personnel about whether antivenom is indicated or not. Here, the epidemiology and recorded history of dry bites are reviewed, and the clinical knowledge on the dry bite phenomenon is presented and discussed. Finally, this review proposes a diagnostic and therapeutic protocol to assist medical care after snake dry bites, aiming to improve patient outcomes.
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Affiliation(s)
- Manuela B. Pucca
- Medical School, Federal University of Roraima, Boa Vista 69310-000, Roraima, Brazil;
| | - Cecilie Knudsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark; (C.K.); (C.R.); (A.H.L.)
- Bioporto Diagnostics A/S, DK-2900 Hellerup, Denmark
| | - Isadora S. Oliveira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo 14049-900, Brazil; (I.S.O.); (F.A.C.)
| | - Charlotte Rimbault
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark; (C.K.); (C.R.); (A.H.L.)
| | - Felipe A. Cerni
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo 14049-900, Brazil; (I.S.O.); (F.A.C.)
| | - Fan Hui Wen
- Butantan Institute, São Paulo 05503-900, Brazil;
| | - Jacqueline Sachett
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus 69065-001, Amazonas, Brazil;
- Department of Teaching and Research, Alfredo da Matta Foundation, Manaus 69065-130, Amazonas, Brazil
| | - Marco A. Sartim
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil;
- Institute of Biological Sciences, Amazonas Federal University, Manaus 69067-005, Amazonas, Brazil
| | - Andreas H. Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark; (C.K.); (C.R.); (A.H.L.)
| | - Wuelton M. Monteiro
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus 69065-001, Amazonas, Brazil;
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil;
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Sasa M, Segura Cano SE. New insights into snakebite epidemiology in Costa Rica: A retrospective evaluation of medical records. Toxicon X 2020; 7:100055. [PMID: 32776004 PMCID: PMC7398977 DOI: 10.1016/j.toxcx.2020.100055] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 11/19/2022] Open
Abstract
Continuous monitoring of the snakebite envenoming allows elucidating factors that affect its incidence at spatial and temporal scales, and is a great tool to evaluate the proper management of snakebite in health centers. To determine if there have been changes over time in snakebite epidemiology in Costa Rica, we conducted a retrospective study using medical records from six hospitals for the years 2012-2013. A total of 475 snakebite patients were treated at the selected hospital during this period. Most bites occurred during the rainy season and primarily affected young men, mainly farm workers and schoolchildren. About 55% of bites occur in peri-domiciliary environments, although its prevalence varies geographically. Bothrops asper generates the vast majority of envenoming in the country, which is why the main local symptoms registered are edema, pain, and bleeding disorders. The time elapsed until treatment did not explain the degree of severity at admission. However, complications were observed more frequently in patients who took longer to receive treatment. The primary complications were bacterial infections, whereas kidney failure and compartment syndrome documented at very low frequencies. Only one death was recorded, reflecting the low fatality rate exhibited in the country. Hospital treatment included the rapid administration of antivenom and complementary treatment of antibiotics, analgesics, and antihistamines. The application of the latter as prophylactic does not seem to prevent the appearance of mild early adverse reactions, registered in 22.5% of the cases. Morbidity and mortality rates from snakebite have continued to decrease in the country, as a result of the efforts that Costa Rica has made to improve its public health system. Among those efforts, the creation of primary care centers (EBAIS) has reduced the time to treatment in many regions of the country. The Costa Rican experience of using antivenom in primary health care centers and maintaining good medical records could be considered for application in other countries where snakebite is a major health problem.
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Affiliation(s)
- Mahmood Sasa
- Instituto Clodomiro Picado, Universidad de Costa Rica, San José, Costa Rica
- Museo de Zoología, Escuela de Biología, Universidad de Costa Rica, San José, Costa Rica
| | - Sofía E. Segura Cano
- Departamento de Farmacología y Toxicología, Escuela de Medicina, Universidad de Costa Rica, San José, Costa Rica
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